Provider Demographics
NPI:1932823226
Name:COBB, STEPHANIE PAULETTE (QMHP, LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PAULETTE
Last Name:COBB
Suffix:
Gender:F
Credentials:QMHP, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 BLEECKER ST APT 204
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3761
Mailing Address - Country:US
Mailing Address - Phone:757-621-6697
Mailing Address - Fax:
Practice Address - Street 1:5332 BLEECKER ST APT 204
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3761
Practice Address - Country:US
Practice Address - Phone:757-621-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002068356164W00000X
VA0732009832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty